Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum in the HAPO follow-up study

It is uncertain whether having a large-for-gestational age (LGA) birth is associated with increased risk for subsequent maternal diabetes in individuals without gestational diabetes mellitus (GDM). Using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study, we estimated the association of having had an LGA birth with developing prediabetes and diabetes 10 to 14 years’ postpartum among those without GDM. Pregnant individuals without GDM in the HAPO Follow-up Study were included. The primary exposure was birthweight category [LGA (>90th percentile), small-for gestational-age (SGA, < 10th percentile), and appropriate for gestational age (AGA) as the reference], accounting for gestational age at birth and infant sex, per the INTERGROWTH-21st international fetal growth standard. The outcome was having developed either prediabetes or diabetes by 10 to 14 years’ after delivery. Poisson regression with robust error variance was used and adjusted for baseline maternal covariates: age, parity, body mas index, height, family history of diabetes, mean arterial pressure, smoking status, and alcohol use. Among 4,025 individuals without GDM (median [IQR] age: 30.2 [25.7, 33.8] years), 13.2% (n=535) had a LGA infant, 7.8% (n=314) had a SGA infant, and 78.9% (n=3,176) had an AGA infant. A fifth (20.0%, n=791) were diagnosed with prediabetes or diabetes by 10 to 14 years’ after delivery. The frequency of prediabetes or diabetes was higher among individuals who had a LGA birth (24.8%) and lower among those who had a SGA birth (15.4%) compared with those who had an AGA birth (19.7%) (overall p< 0.01) (Table 1). In multivariable analyses, individuals who had a LGA birth were at higher risk of having prediabetes or diabetes compared with those who had an AGA birth (adjusted risk ratio, aRR: 1.21; 95% CI: 1.02 to 1.44) (Table 2). SGA birth was not associated with the outcome. Among individuals without GDM, having a prior LGA infant increased the risk of being diagnosed with prediabetes or diabetes by 10 to 14 years’ postpartum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)